The Discussion section provides a discourse of strengths and limitations of the Capstone team’s community engagement activities, considerations for the sustainability of the
deliverables, the potential impacts of the Capstone project, and challenges and lessons they encountered.
Strengths and Limitations of Engagement and Assessment Activities
As discussed previously, engagement with community partners and intended beneficiaries provided researchers with direct access to the diverse perspectives and
understandings of the health issue. As such, the Capstone team both valued and appreciated working with the Project imPACT research team but also struggled with the lack of engagement with imPACT participants. Capstone team members were not formal members of the research team and therefore did not interact with imPACT participants. Additionally, participant
recruitment for the intervention was only just beginning as the Capstone team was ending its work, further limiting opportunities for engagement. This limitation was of particular concern when developing the process evaluation interview guide for use with the Project imPACT participants. The interview guide focused on learning about the participants’ experiences with the intervention, including satisfaction with the overall process and also with each of the intervention components. Having the opportunity to pilot the interview guide and possibly conduct cognitive interviews to assess the questions for meaning and other features, as well as
receive feedback from the intended beneficiaries, would have strengthened this deliverable. Although they were not participants of the intervention, the Capstone team was able to engage with members of the target population, formerly incarcerated PLWHA, through a focus group. From the information collected, the Capstone team derived a summary of analysis to be used to inform the intervention during implementation.
Additional strengths of the Capstone team’s engagement activities included collaboration with the Project imPACT research team, the Capstone team’s other primary stakeholder group. Collaborating with these stakeholders on an ongoing basis facilitated the development of appropriate measurement instruments, making efforts more effective and efficient, while also establishing a mutual trust that enhanced the quantity and quality of data collected
(Viswanathan, et al., 2004). The Capstone team’s relationship with the Project imPACT research team could have been improved through the Capstone team’s continued participation in Project imPACT research team’s regular staff meetings, which were suspended in the fall.
The greatest weakness in engaging with this stakeholder group was structural in nature. Because the work of the Capstone team was limited to only one component of the Project imPACT intervention, linkage-to-care, the process evaluation tools were confined in the information they could provide. The team found that this intervention fragmentation restricted their ability to help refine the overall intervention based solely on the linkage-to-care process evaluation, in addition to limiting Capstone team engagement with the intervention team aside from the linkage-to-care coordinator. Broader involvement of the Capstone team in Project imPACT’s efforts would have strengthened the Capstone team’s deliverables.
Considerations for Sustainability
Due to the nature of the research project, the Capstone team not only had restricted interaction with imPACT participants but also had a limited role in planning for sustainability. Since Project imPACT was not a research project that yielded the types of sustainability that
Shediac-Rizkallah & Bone (1998) identified, the Capstone team could only discuss the factors that could potentially influence the continuation of the Capstone’s deliverables within Project imPACT. As part of the ongoing initiatives of Project imPACT, the Capstone team expected that the research team would sustain the Capstone team’s efforts by using the tools after the
completion of the Capstone term in May 2012 and conduct analyses of the data they collect in 2012-2013.
The Capstone team proposed specific factors for the research team to consider when planning for imPACT’s sustainability. First, the research team could incorporate specific project design and implementation factors to increase the potential for sustainability of the intervention. As discussed in the Results section, the research team should make efforts to disseminate their results, manuals and protocols, which would include the process evaluation and cost tracking tools, should the intervention be proven successful.
Furthermore, strengthening the organizational capacity of North Carolina’s HIV clinics, ASOs, and prison system could help enhance imPACT’s sustainability. CFID and Project imPACT could collaborate with these organizations to identify ways and resources that could help them integrate the intervention and evaluation measures into their existing systems.CFID and Project imPACT could also put measures in place to monitor replications of the intervention and the outcomes produced, in addition to providing training and technical assistance to
researchers and practitioners. The Conclusion section proposes steps to ensure the sustainability of the Capstone team’s work.
Potential Impacts and Benefits
Through the efforts of the Capstone team, CFID and Project imPACT gained valuable information and tools to help strengthen the implementation of the intervention, thereby leading to potentially significant impacts for formerly incarcerated PLWHA and their communities. The implications of these intended benefits were not only wide-reaching but also enduring. At the
conclusion of the Capstone team’s involvement with Project imPACT, Project imPACT staff maintained the resources produced by the Capstone team. These resources, such as the process evaluation tools, would strengthen the staff’s assessment of the intervention
implementation and could serve in future replications of the intervention. The development of the process evaluation tools also helped the Project imPACT research team to clearly specify the details for implementing the intervention. For example, when developing process objectives and indicators, the research team and Capstone team referenced the Standard Operating Procedures (SOP) for the linkage-to-care coordinator to determine what roles she would be performing, which became the evaluation’s indicators for measuring the frequency of each intervention component delivered to the participants.
Additionally, the linkage-to-care cost tracking tools provided a valuable resource by which to conduct future cost analyses of expenses incurred during development and implementation phases of the intervention. Lastly, direct involvement and feedback from members of the target population, formerly incarcerated PLWHAs, in the qualitative research process boosted the relevance and impact of the linkage-to-care intervention.
Lessons Learned and Challenges
Each member of the Capstone team learned valuable lessons through the course of conducting a successful Capstone project. Close and effective coordination among team members was necessary to ensure that all deliverables incorporated each member’s insights, producing work based on collective consensus. All project-related issues were addressed in a timely manner within the team through this deliberate coordination. Furthermore, the team reinforced lessons learned through the 2-year Health Behavior Master’s curriculum by directly applying qualitative and quantitative research and evaluation skills to the efforts of Project imPACT. In the development of focus group and interview guides, the Capstone team
above in the Literature Review section, which focused on individual, community, and policy levels of influences on a behavior (Glanz, Rimer, & Cancer Institute, 1997). Finally, the
Capstone team also learned about the many steps, processes, time, and manpower required to establish and evaluate an intervention such as Project imPACT.
Key challenges of the Capstone project stemmed from continual changes to some of the Capstone deliverables over the course of the year. Such modifications created a domino effect of changes to other components, oftentimes delaying the completion of the Capstone work. Further complicating the timeline, delayed communication with stakeholders also proved to be a challenge in the timely completion of projects for some deliverables. Aside from the community partner, interaction between the Capstone team, imPACT participants and Project imPACT staff was limited, creating barriers to the establishment of relationships and engagement with key stakeholders. Although the work expected of the Capstone team was within the scope of members’ skills, the team would have benefited greatly from enhancing their skills by learning how to analyze the data collected through the process evaluation and cost tracking tools they developed, which was not possible due to previously mentioned time constraints. The data collection and analysis process using these tools, however, will occur outside the timeline and purview of the Capstone team’s involvement with Project imPACT. Finally, the Capstone team struggled to address the format and expectations for deliverables set forth by the Health Behavior teaching team due to the evaluative and research-based nature of the deliverables.